by The HLH Team
Transportation is the most logistics-oriented waste. It’s the unnecessary movement of materials and, while healthcare isn’t moving tonnes of scaffolding and concrete, the materials being moved are far more precious and delicate.
For sake of comparison between Transportation and Motion waste (the latter traditionally focused on staff), we’re going to zero in on the movement of patients, as well as materials. Healthcare demands that we move patients back and forth and each move required resources. It’s our job to keep asking ourselves whether we’re doing it in the most efficient way possible.
No Value:
Transportation offers no value to the patient. In fact, the longer that any transportation takes, the more potential harm it could cause to patient well-being.
In the medical industry, it’s also one of the wastes that you can cut freely with little restriction from stringent guidelines. More so than other industries, healthcare must navigate complex waters of regulations and red tape when fighting some of the deadly wastes, but this is not so with Transportation.
Running Down Hallways:
This waste starts at the beginning: with building layout. Do you need to travel to the other side of the clinic everytime you need a basic medication?
Your storage room should be located near the centre of the action. If it’s not, consider a smaller, secondary storage space for your staff to grab the basics that they need every day.
If there’s medication you’re using all the time, consider bringing it from the pharmacy to where you need it most to avoid travelling to get it. A lot of transportation waste reduction comes down to listing the materials that you use most and streamlining the logistics to get them where they’re needed.
Moving Patients:
Every time a patient moves somewhere, someone needs to prep the room, show him or her the way, and reset the last room for the next patient. Think about all the reasons why you shuffle and shift patients through your clinic. Are they all necessary?
Do patients have to be moved across rooms because specific equipment isn’t available in the first room? If so, could prep be done ahead of time to prep the first room, based on an estimation of patient needs, so 2 rooms don’t need to be prepped and reset from the start?
Perishable Material:
You can’t afford to move samples and other highly perishable materials more than necessary. Make sure that, when they’re taken, they are moved to a central location in the clinic to be dealt with appropriately from there (ie. moved to the lab or examined in-house).
The Other Kind of Waste:
You’ll generate medical waste as a natural part of your practice. Disposing of it is tightly regulated with strict guidelines for non-compliance. Many healthcare providers use a third party company to ensure proper transport and disposal of their medical waste.
by The HLH Team
Unlike manufacturing, wherein materials are assembled at home base, construction happens remotely, where literally tonnes of materials are being moved around each day.
Bullets don’t win wars, but logistics do. The same rules apply with construction. If the proper materials aren’t in the right place at the right time, downtime accumulates quickly.
Lean Thinking:
Building a house involves dozens of stakeholder groups all contributing to the whole, while prioritizing their own individual interests. Their logistics are largely their own, because they’re not motivated to collaborate. Lean thinking seeks to pivot the focus toward the value of the project as a whole, rather than its individual pieces. When partners collaborate with more than lip-service, value goes up, cost and frustration go down, and everyone benefits.
If the plumber needs to run to the store, maybe the electrician needs something. Rather than making two separate trips, the two could be tackled at once, saving time. With our current system, a process like this may feel like science fiction. However, if you change the conversation so the “task list” becomes a series of commitments that everyone is engaged with, in order to bring more value to the product, it’s not far off.
Staging Area:
This sounds self-explanatory, and it largely is, but it can also fall through the cracks when you’re rushing through setup time, trying to get started.
Take the time to map your jobsite, indicating where to stage your equipment, trucks, and materials. Mark your traffic flows and walkways. Ensure your delivery drivers have a reliably open path to the stage to avoid honking, panic, and overall chaos.
Distance Trumps Discounts:
Where are you buying your materials? Often, far away suppliers will tantalize you with discounts, but do your logistical math. If the fuel costs check out, and you’re not having to build up excessive inventory levels (more on that later), it may pay off for your initial shipments.
During the job, however, don’t send your foreman driving 40 km for fill-ins. You’ll always need last-minute deliveries, but there will always be local businesses to supply you. The 20% extra is well worth the cost of saving fuel and keeping a senior person at the jobsite for hours at a time, rather than on the road.
Check the Address:
This is the biggest “facepalm” Waste of them all. It’s also inexcusable in our technological age, and low-hanging fruit for improving Transportation Waste.
You should have zero tolerance for wrong address deliver. Bad handwriting or false inputting should never be an excuse. Your drivers should always confirm the address with someone on-site and take the extra 20 seconds to use Google Maps.
Keep Accurate Logs:
Many stakeholders in any construction project hate paperwork, but if you let your mileage logs fall behind, you’re sending your trucks out blind. It’s a sloppy habit that can easily snowball into massive Waste.
It may not catch up to you for a while, but it will hurt when it does. Roadside breakdowns or failed roadside inspections are profit killers. Even worse is finding yourself replacing critical and expensive equipment pieces because routine maintenance fell behind (due to improper logging). As painful as they may feel at the time, keep up to date with logs and prevent breakdown further along the line.
by The HLH Team
It’s easy to confuse “Transportation Waste with “Motion” Waste. The former is the unnecessary movement of materials, while the latter is the unnecessary movement of people. Manufacturing is full of both.
General:
Transportation Waste happens at every point in the supply chain, from raw material delivery to final assembly. To identify these Wastes, follow that chain and make note of the usual suspects along the way.
Here’s what you’ll find: Waste happens everywhere, but the instances happen less the earlier you are in your supply chain, as they are more costly per instance. However, while it’s more glaringly obvious with half-empty semis, half-full carts can be just as expensive due to increased frequency.
Waste Spin-Offs:
No Waste is an island. Besides wasting time, fuel, and giving you a stress headache, excessive transport can also lead to:
- Over-Inventory: things get stacked up in temporary places only to be sorted through later
- Defects: moving materials leads to dirt, damage, or loss.
- Waiting: the more you shuffle things around, the less likely they’ll be in their designated spot when needed, resulting in waiting.
Start with your Supply Chain:
This begins with thinking of where to set up shop, but continues throughout the life of your business. How close are you to your vendors? If it’s excessive, and you’re back and forth often, is it worth paying little more upfront for closer suppliers? Don’t assume: do the math.
Half-full trucks are a glaring Waste. Find partners to share, even if that’s with a competitor (only if your vendors ensure confidentiality, of course).
Don’t fear the milk run. We assume that direct routes are more efficient and they often aren’t. When that trailer full of raw materials lands at your dock, is it going to gum up your processes to store it all?
How’s your Storage?:
Transportation Waste tends to be more obvious in receiving rather than production.
You’re getting regular deliveries. Are the trucks being unloaded into temporary storage that you’ll need to move again later, or are they going directly from first storage point to production? Plan for the latter, unless a small storage area at point of production is necessary (see below).
How full are your carts? Are your forklift operators driving with half-loads when they could be full? Always opt to maximize your transport efficiency between processes, especially if it’s a longer distance. There’s a caveat though: sometimes loading the last third of that cart involves waiting or motion waste that kills the efficiency.
Keep your lanes clear. If you have to weave around piles of temporary storage and random clutter, you’re wasting resources in so many ways. Paint lines for runways to keep clear between processes, if you have to.
Your Production Area:
Whether you’re making cars or crayons, your job is to assemble raw materials into a finished product in the most efficient way possible. When a worker frequently needs raw material, anything further than an arm’s length away is wasteful.
Are all materials close-at-hand when needed? If not, what’s the process in getting them from storage to the production area? If you’re bringing raw material over in tiny batches often, ask yourself if it would be beneficial to establish a smaller storage area at the point of production.
This tactic is closely tied to Motion Waste. Once you bring your raw materials closer, you can zero-in on the steps and movements your workers need to take.
by The HLH Team
In healthcare, over-processing usually takes the form of patients being treated longer, and often more extensive, than is needed. From filling out excessively long forms to tests that aren’t needed, there are many ways we can trim our process, stay within care guidelines, and cut waste.
Unlike other industries, healthcare’s funding model sometimes pays for over-processing, which puts clinics in the awkward spot of either increasing the efficiency of the medical system overall or looking to their balance sheets. Other cases of over-processing are truly internal, and clinics must identify and confront them like any other industry.
Patient Intake:
Over-processing waste often starts at first contact, especially with new patients. When they fill out the form, how many data fields are you actually going to use? If you’re not planning to email them, for example, why ask?
Are patients filling the forms out long hand? This can cause spin-off frustrations (who moved the clipboard?), as well as potential data-entry time. Every time someone has to read or interpret handwriting, we’re opening the door for additional waste.
Why not have a tablet accessible so patients only fill out the form once and the data syncs to whatever other forms are required? Not all patients may be comfortable using that technology, but those who are can save you data entry time and potential mistakes.
What does the Patient Need?:
When a patient needs additional treatment after the first appointment, over-processing can happen a number of ways:
- Referring to a Specialist when a Primary Provider can provide the same care
- Ordering unnecessary testing, like asking for an MRI when an X-ray would yield the same answers
- Requesting surgical intervention when there’s an available and effective medical alternative
Sometimes this over-processing waste will actually add efficiency at the clinic level because it moves the patient to excessive care elsewhere. But Lean thinking emphasizes optimizing value at the broadest level, and adding waste to the system as a whole decreases value to the patient overall.
The key to nipping over-processing in clinics, as it is with other industries, is to enforce the standardized referral practices. Training and reinforcing documented referral guidelines with your medical staff will keep rules clear and help avoid over-processing causing procedures and tests.
Follow Ups:
We often ask for follow-up appointments with patients. These are often valuable tools for connecting and checking progress. Sometimes, however, they’re redundant.
If a follow-up exists to simply check in and ask one or 2 questions, consider a phone call or a virtual Skype call instead of in-person.
Unfortunately, how clinics are reimbursed and Lean thinking don’t always go hand-in-hand, and reducing follow-ups may not always be in the clinic’s financial interests. However, as far as overall value goes, we need to consider everywhere that over-processing happens.
Audit your Tasks:
Your staff perform some processes dozens of times a day. As with Motion, the priority we should give to focusing on any task for process improvement correlates with how often we do it. Math doesn’t lie.
Choose a process and map out every step taken in it. If you have a pharmacy in-house, for example, how many steps does it take from the doctor’s chicken scratched Rx, to the pills being handed over, to documenting after the fact. You might find that a dozen or more steps can be safely and substantially reduced.
by The HLH Team
Over-Processing is what happens when you do your job better than you’re going to be paid for. It can be accidental or deliberate, built into processes or spontaneous, but it’s all Waste.
It can be anywhere and is often hard to see. Here are a few of the usual suspects:
Pricing Insecurity:
No matter what business you’re in, it’s crucial to be confident of the value of your product. If you’re not, you may nurture an internal culture where you or senior staff feel obliged to do more than is required, for fear of losing the customer.
This isn’t discussed much, but it’s a pernicious business Waste. Whatever causes it (we’ll leave the psychoanalyzing to the experts), it results in lower margins due to adding value when not required, at various steps of the process.
Customers won’t tell you when you’re doing too much: they’re good with all free added values we throw at them. When you unilaterally upgrade material or add features, it’s very unlikely that you’ll see any ROI from it. It is likely, however, that you didn’t need to.
Be clear from the beginning, with the customer and with yourself, what the promised product is. Articulate it well, and don’t deviate without a signature.
Establish Governance:
A lot of Over-Processing happens when we literally don’t know when to stop. Unless you’re getting paid for perfection, don’t make it. The standard you construct needs to meet inspection and then reflect the value that the customer is paying for. If they want value added from there, they need to buy it.
Related to that, make sure to document every time a foreman, contractor, or estimator makes a “minor change” to any planning or drawing document. Minor changes tend to be forgotten about, not be billed, and add up quickly.
As part of planning every job, document who is giving the final say. In smaller firms, this will be the owner, but will often be delegated to a VP or other manager in larger companies. The person with the final say is also accountable for processes being done to paid value and not beyond. Having them answerable for that Waste will maintain motivated vigilance.
Use the Resources You Need:
The classic construction site scene that we all snicker at is 2 guys working, 3 guys watching. Over-Processing isn’t just not getting enough ROI for doing extra, it’s also devoting too many resources to a project than you need.
Deadlines, pressure from above, or just wanting it done quickly are all culprits. We put too many people and/or pieces of equipment into a site where they can’t properly function around each other. The result is Motion Waste, potential safety hazards, and lack of progress on the jobs you pulled them from. These all combine into the frustrating slurry that is Over-processing.
Signatures Matter:
What the boss asks for and what the customer asks for are sometimes totally different things. Customers (homeowners being most notorious), will sometimes ask for upgrades informally, whether that’s higher-end material or whole new features, during site visits.
Get their signature. If you don’t, you may discover the homeowner’s sudden amnesia while looking at their invoice, leaving you grappling with a he said/she said scenario and an upgrade that you’re not getting paid for.
by The HLH Team
You create a finished product out of raw materials. You’ve paid for it, and usually have a little wiggle-room to add margins based on possible differentiators.
If you add something extra to a widget that matters to your customer, they’ll pay more money. If you add something that doesn’t, they won’t. The money you waste by adding something without value is Over-Processing Waste.
In your Processes:
Let’s look at it like mixing coffee. A few twists of the stir-stick is usually enough, but we often add another ten. While five seconds wasted per cup isn’t world-ending, it’s wasted time that could be spent elsewhere.
Walk through your processes with several trusted team members; one isn’t enough. Over-Processing is often buried in personal habits (like excessive coffee stirring) and varies by person.
Polishing Cannonballs:
The good news is that if Over-Processing is built into your manufacturing, improvements aren’t difficult.
Again, get involved in the processes:
- Are you painting areas that won’t be visible or exposed to corrosion?
- Are you polishing a surface that doesn’t require it?
- Are your guidelines excessively tight, requiring wasteful levels of detail and scrutiny?
If Over-Processing exists, the customer will likely not notice or care if you change it. If it adds value, however, you’ll hear about it. Before trimming Over-Processing, sleep on proposed changes and make sure you strongly consider the customer, their needs, and your MVP (see below).
Standardize:
In the world of efficiency, there is the most efficient way, and all other ways. It’s like how one, and only one, car can win a race.
If two people are performing the same function in different ways, one is more efficient. Document the better process and train everyone to do it that way.
Keep your standardization organic, especially if just starting out. The next person may have a more efficient way, and so might the person after them. The more empowered your team feels to share their ideas, the more efficient your standardized processes will become.
MVP:
Pricing a product is one of the most delicate things you could do. There’s the best practice of using competitive products to benchmark, but to find a margin, you’ll likely add some differentiating features.
Finding the right balance between what customers are willing to pay and what you’re willing to charge is difficult, and you never know for sure if you’ve gotten it right. When we’re unsure, many of us start adding to our products to improve sales.
Try this: write down all the features of your product, no matter how small. Separate them between what your customer needs and what they would like.
The first column (Needs) is your Minimum Viable Product (MVP). It’s the essential core to your product. These features are untouchable.
The second column (Wants) are your added value features. Here’s where to get critical. Does your customer want each of these features enough to pay for them to increase your margins? Or are they frills that won’t give you visible ROI?
With each new product and feature you want to add, repeat this exercise. If the customer isn’t willing to pay, don’t add it.
